Harmonizing: a North American Indian approach to management of middle ear disease with transcultural nursing implications.

In a grounded theory study of Canadian Indian family management of persistent middle ear disease, harmonizing was identified as the major strategy employed in the process of learning to manage. This finding resulted in a recasting of the substantive theory of management identified in an earlier study of Caucasian families. Although families from both cultures advance and retreat on the continuum of learning to manage in response to the relationship with the health care system, the effects of the disease on the child, and the amount of disruption in family life, culture was found to influence the ways in which these families learned to manage. In general, native families harmonized by integrating the experience into their reality in contrast with their Caucasian counterparts who attempted to direct or take charge of the experience. Factors that influenced native Indian management included autonomy of the child, perceptions of health and illness, expectations of the health care system, orientation to present and past time, and listening skills. These findings significantly contributed to the development of transcultural nursing knowledge.